Tag Archives: relationships

When the behavior of others negatively affects clients’ mental health

By Bethany Bray June 1, 2021

In a 1624 devotion, the English poet John Donne argued, “No man is an island, entire of itself; every man is a piece of the continent, a part of the main.” 

This sentiment still rings true in modern-day counseling. Behaviors exhibited by other people in clients’ lives — often the people they love most — can affect them acutely. When these patterns are codependent, manipulative or unhealthy, it can cause clients’ presenting issues to worsen, stall their progress in counseling or otherwise negatively affect their mental health.

Examples run the gamut from an adult client whose parent deals with anxious feelings by being critical of or over-involved in the client’s life to a client whose spouse has experienced past trauma and is prone to angry outbursts.

These types of scenarios are not uncommon, and they often surface as counselors and clients begin to unpack the issue(s) that brought them into therapy, says Jen Ohlund, a licensed associate counselor (LAC) who counsels adolescents and adults at a practice in Mesa, Arizona. One indicator that a client is not getting the support they need from the people in their life can be failure to make progress in counseling, despite hard work on the part of both the client and counselor.

In counseling, a practitioner might hear clients make statements such as “I feel like I’m getting better, but I go home and I keep being told the same [unhealthy] things over and over again” or “I am doing everything I can and nothing is changing,” Ohlund says.

“Any progress they’re making is being shot down by the other individual,” she explains. “That’s when we introduce boundaries. We talk about what a healthy boundary is and equip them with [psychoeducation] that we can’t control how other people react. We can’t always walk on eggshells. Sometimes other people have to work through their triggers, and if they’re not going to do that, we have to set boundaries.”

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Seeing the whole picture

Empathic listening and validation from a counselor can serve as important first steps with clients who are wrestling with guilt, aggravation, sadness or other feelings spurred by the behavior of loved ones, Ohlund says. Simply talking through what has and hasn’t been working can be powerful, as can receiving assurance from a counselor that many people struggle with similar challenges and the client is not alone in feeling those same emotions.

“A lot of times, they don’t want to feel this way. They care and love this person,” says Ohlund, a member of the American Counseling Association. “They might feel overwhelmed [or] frustrated with their loved one or turn inward and beat themselves up, feeling like they’re not doing something right [or] not doing enough to meet [the other person’s] needs.”

Counselors can also listen for indicators that clients are struggling with isolation, a lack of boundaries (such as receiving an extremely high number of text messages from a family member) or feelings that they can “never say no” to their loved one. In these cases, clients might not have other people in their life who can act as a sounding board to give them a clear perspective. One way counselors can help clients temper the unhealthy messages they receive from a loved one is to support them in finding connection with other people who offer positivity and a voice of clarity. This will help clients self-regulate, Ohlund notes.

Michelle Fowler, an LAC at the Arizona Center for Marriage and Family Therapy, urges counselors to help these clients through an attachment lens. “We are wired to need one another and respond to one another. Doing therapy in a bubble is very unrealistic,” Fowler says. “The relationships around the client have the greatest influence on their well-being. It’s neglectful of us to ignore those contacts or not address them when they are a source of [a client’s] distress or, potentially, a resource to help in recovery.”

Asking targeted questions during the intake process is a good way for clinicians to get a picture of the supportive factors in a client’s life, says Breanna Lucci, a licensed mental health counselor at a group practice in the North Shore of Massachusetts. These questions can include:

  • Who is in your support system? Who can you turn to for support?
  • Who makes you happy?
  • What are your standards in a relationship, and how do you know a relationship is a healthy one?
  • Does your family know that you’re going to therapy, and are they supportive of that decision?
  • Describe your living environment. Is it supportive?
  • Who (other than your counselor) are you comfortable talking to about topics related to mental health?

Lucci also finds that discussions about a client’s self-talk can uncover outside factors affecting their mental health. She uses motivational interviewing with clients to delve deeper into these external influences.

For example, if a client says, “I’m anxious, but I just need to get over it,” then Lucci, an ACA member, asks, “Why do you feel that way? Where have you heard that?” Or if they say, “I’ve been told I’m stupid,” then she breaks down what “stupid” means to the client and asks, “Who said that? How did it affect you?” Talking through a client’s language choices in this way helps them to recognize patterns and realize how things they have heard from others and internalized have become part of their self-talk and self-belief. The goal of this work, Lucci stresses, is always for the client to get to these realizations on their own.

Carrie E. Collier, a licensed professional counselor who specializes in Bowen family systems theory at her Washington, D.C., practice, agrees that the language clients use in session about their relationships can relay valuable information about the client’s context and how they respond to others.

“An individual is not in a vacuum — there’s always reciprocity in relationships,” says Collier, director of the Bowen Center for the Study of the Family in Washington. “Anxiety is contagious; if a person is living with other people, there are a lot of shared emotions that are going on. I try and help a person get really clear about what’s theirs and what’s the other person’s, and what he or she is putting into it and what [others] are putting into it. … As a counselor, it’s important to see the [client’s] entire context and the landscape. It’s not just one person sitting in the office with me. It’s not a cause and effect. It’s relationships and people reacting to one another, and that is what the counselor and the client are up against.”

Fostering understanding

With those who are surrounded by unhealthy patterns, it is vital for counselors to be aware of resources (both in their local area and online) that can help clients better understand what their loved one is going through and support the client outside of counseling sessions, Lucci says.

As a licensed drug and alcohol counselor, Lucci is knowledgeable about numerous addiction resources in her area, including a recovery center that offers interventions and free family workshops. She often recommends Johann Hari’s TED Talk, titled “Everything you think you
know about addiction is wrong” (see bit.ly/3aqbpV4), to clients whose family members struggle with addiction. She also has a ready list of organizations that offer support groups and other resources to help those whose loved ones live with mental illness or who struggle with parenting issues, caregiving roles, work stress, an incarcerated loved one and a range of other challenges. The support groups and educational materials from the Depression and Bipolar Support Alliance (dbsalliance.org) and the National Alliance on Mental Illness (nami.org) can be particularly helpful, she adds.

Finding avenues of safe support outside of counseling equips this client population to “be healthy in spite of their circumstances, and some of that is [learning] acceptance,” says Fowler, who counsels adolescents, individual adults and couples. Understanding the big picture that frames a loved one’s behavior (including, in some cases, mental illness) empowers clients and can help them “gain empathy or understanding so it doesn’t feel like a personal attack,” Fowler explains. 

Roughly one-third of Fowler’s caseload is adolescents, and for these clients, questions about the adults in their life can reveal important information about the support they are — or aren’t — receiving at home, she says.

“One place that I always start, especially with the adolescents I see, is the assumption that if they could go to the adults in their circle to deal with their [presenting] problem in a supportive way, they probably wouldn’t be in my office,” says Fowler, an ACA member. “Sometimes it turns out the parents have mental health issues and the client is doing as best as can be expected. It is definitely not happening in a vacuum. … If somebody else really is why, or part of why, they are struggling, is that a person who could be involved in therapy? Is this a person who could potentially help, or does the client need coping skills to deal with [this person]? If it’s a parent and child, I definitely want the parent to come in as much as possible. But if that parent isn’t going to be a safe person because they have their own struggles or are not willing to adjust, be open and see [the] child’s perspective, then how do I shore up [the client] with coping strategies?”

One example Fowler has seen among her caseload is clients who identify as LGBTQ and “have gotten very clear messages from their family that they’re not open to talk about it.” These clients are left to work through their identity and mental health issues on their own — an experience she describes as a “personal journey of how to make peace with themselves while staying in their current environment.” 

For couples and individual clients, a dose of honesty from a counselor about how much their situation could improve may be called for, Ohlund notes. “We [counselors] don’t necessarily give advice to clients, but I also think it’s important to be clear that in some situations, if you continue to stay in this relationship, this is what it will look like. If you learn all of these coping skills and boundaries and nothing else changes, the relationship won’t be better. You can maintain the relationship and be stable, but thriving is a completely different thing,” Ohlund says. “It’s important not to be vague. Be very clear [about] what it would look like if they chose different options so they can weigh it appropriately.” 

Even as clients grow through counseling, the other person in the relationship may not change. This concept is so important, Ohlund points out, that it is written into the informed consent forms at the practice where she works.

“This is one of the most difficult parts of therapy: When you grow and develop, the people around you may not,” Ohlund says. “Once [clients] learn coping mechanisms, communication skills and begin to feel more confident … they may find that the relationships around them change, or they may not even want [those relationships] in their life” any longer.

Counselors can serve as vital resources to help these clients work through self-judgment, anger and other feelings, while equipping them with coping mechanisms such as mindfulness, self-care and self-compassion exercises, Ohlund says. She acknowledges that helping clients learn to see things through a new, healthier lens takes time. Along the way, it is important to help clients focus on the things in their life that are going well, she says.

Rewriting unhealthy patterns 

Fowler once worked with a teenage client whose presenting issues were depression, self-harm and suicidal ideation. The client’s parents had gone through a tumultuous divorce seven years prior, and her father had since remarried. The parents had 50-50 custody of the teen and continued to squabble, sometimes in front of her.

The environments at her mother’s and father’s homes were opposite. The only communication she received from her father involved correction or discipline. His home had much stricter expectations around behaviors and schedules than her mother’s home did, and the client also had stepsibling relationships to navigate at her father’s home. Because the client’s friends lived closer to her mother’s home, she had more opportunity and freedom to connect with her peers when staying with her mother.

The teen was “upside down” on whom she could trust, Fowler recalls. She was exhibiting attention-seeking behaviors online and had been hospitalized for suicidal ideation before Fowler’s work with her. 

Fowler took a different approach from the teen’s previous therapist, who had not involved the parents in the counseling sessions. Fowler focused on rewriting the parent-child and parent-to-parent communication and response patterns that had become unhealthy. She also invited the client’s mother, father and stepmother into counseling, first in a group session without the client and later with one of the adults in sessions with the client.

Fowler used emotionally focused therapy with the teen to help her learn to explain what she was feeling to her parents. The method focuses on exploring primary emotions and practicing communication of those emotions in a way that the client’s attachment figure can receive, Fowler explains. By helping the client share — and the parents truly hear what she was saying — the mother and father were better able to understand the seriousness of their daughter’s depression and the impact their discord was having on her. This experience also tapped into her father’s empathy and allowed him to put his anger aside, Fowler recalls.

Fowler also worked with the adults on how to respond to their daughter in helpful and supportive ways. “I explained that [she] is looking for support and safety and is not feeling loved or feeling approved, so she’s looking for it elsewhere,” Fowler says.

The parents agreed to stop arguing in front of the teen, and the father had a change of heart and began to plan activities to be able to spend time with his daughter in a positive way. Within months, the teen was feeling much better, and her self-harm behaviors and suicidal ideation dissipated, Fowler says. Although her parents still have to monitor her cell phone use, the client’s situation has greatly improved.

“All of that contention, seemingly overnight, went away,” Fowler says. “I know that the changes that the parents made were a huge factor in helping the child.”

It “took some convincing” for the father to change, Fowler recalls. His frustration toward his daughter stemmed from feeling that she was being unsafe online and making herself available to strange men. Ultimately, Fowler used those feelings as leverage to explain that he had a chance to be the safe man in his daughter’s life.

“That was the window that helped him see … [and] understand how he had the opportunity [to make] his daughter feel loved,” Fowler says. 

Setting boundaries

Boundary setting is one of the most important coping mechanisms a counselor can provide to clients who are surrounded by unhealthy patterns. Even though clients cannot control a loved one’s behavior, they can control the boundaries they choose to establish in the relationship, Ohlund notes. This work must be client led and will look different for each person, based on their preferences and needs.

Exploration of boundaries is best done in session when the environment is calm — before the client needs to confront a loved one in the heat of the moment. Clients should not set a boundary until they are comfortable enforcing it, Ohlund stresses. The counselor and client should also talk through what it will feel like to enforce the boundary, including understanding and preparing for the possibility that it may make the other person feel worse, including triggering anxiety or feelings of abandonment.

Sometimes people may not understand these new boundaries. “Those who benefit from not having boundaries won’t want to deal with what’s going on with them and are going to fight it a lot,” Ohlund points out.

Ohlund often works with clients to establish boundaries that have stages that are customizable if or when a situation arises. For example, if a client has a spouse or family member who is prone to critical or angry outbursts, the first step might be for the client to leave the room or go to another part of the house. If the behavior continues, the client could leave the house for a brief time. Similarly, they could choose to temporarily block the phone number of a family member who is prone to sending a barrage of text messages when that person is upset.

“This is much better than just asking them to stop. What will you do when [the behavior] doesn’t stop? We have to set a boundary that we have control over so we don’t get sucked in or pulled in,” she says. 

Ohlund once had a client whose mother did not approve of some of the ways he and his partner chose to parent their children. She would repeatedly overstep her bounds and impose her opinions on the children. The situation pitted the client’s children against him, Ohlund says.

The mother continued the behavior even though her son spoke with her about it multiple times. Eventually, with Ohlund’s support, he set a boundary that if his mother continued to disparage his parenting style to his children, he would cut off his family’s contact with her for one month.

The mother did not stop her behavior, so the client followed through and cut off contact. During that time, his mother criticized him to other members of their extended family. “He knew it was the right decision, even though it was tough,” Ohlund says. “Eventually, the mom did come around, although it took a considerable amount of time to come to that point.”

This client’s decision to hold firm to his boundary resulted in a positive outcome, but that isn’t always the case. Sometimes people don’t agree with the boundary, which can create a disconnect or distance in the relationship, Ohlund says. “The reality is that [people] don’t have control over whether someone else is going to respond or not respond. It can be very disheartening and something to grieve and think of as a loss. It’s something you are working very hard on, but it’s out of your control,” she notes.

Collier stresses that the goal of boundary setting should be to guide clients to find what’s best for their own mental health, based on their principles. It also involves reflecting on what has and hasn’t worked in the past.

“The goal is not to get the [other] person to change. That’s very important [to understand]. If you are doing something out of your own principle, then it doesn’t matter how the other person responds. You want to say it to them not because it will help them or prompt change but because it’s your principle. It will only work when the [client] has done their own principled thinking,” Collier says. She advises counselors to ask good questions and stay out of the client’s emotional process: “Don’t jump in and become involved in [a client’s] emotions. Just get them thinking about ways to do things differently.”

Lucci agrees that effective boundaries must be rooted in a client’s values. Part of this process may involve having a wider conversation on what the client’s relationship standards are, including what they want out of the relationship and what they feel is required to continue the relationship.

“Setting boundaries can be extremely uncomfortable for people, and that’s why I emphasize that [boundaries] continually change and can be adjusted,” Lucci says. “[This process] is not one session. It’s a very slow process, and it’s adjust, adjust, adjust.”

Clients who are working to establish boundaries may find it helpful to practice the necessary conversations with a counselor before initiating them with loved ones. For example, what might it feel like not to respond to a text from that person? Collier notes that a counselor can talk this scenario through with a client, acknowledge how hard it will be and assess whether it feels like the right thing to do. “Know that there is going to be an uncomfortableness; saying no is going to be hard,” Collier acknowledges. 

It may also be helpful to focus on communication techniques with these clients, including how to bring up sensitive or triggering topics with a loved one in a nondefensive way, Lucci adds. Counselors and clients can practice taking in comments and information from loved ones and then expressing themselves without spurring debate or becoming defensive. In this vein, Lucci sometimes encourages clients to write a dialogue down and read it back to her in session.

“It’s natural to get really anxious about these conversations, and a counselor can help alleviate some of that anxiety by preparing [with the client],” Lucci explains. She asks clients what the goal of the conversation is and how they want to approach it. “It’s really important to listen to what the client wants,” she says. “I want the client to feel empowered and have knowledge, but ultimately it’s their own decision” regarding how to handle the situation.

The counselor’s role

Counselors play an important role in helping clients whose mental health is negatively affected by the toxic patterns of others in their lives. These patterns may indicate that the other person needs counseling themselves, but first and foremost, the counselor’s ethical duty is to help their client, regardless of whether it is appropriate or possible to involve family members or others in their counseling sessions. (An important caveat is when counselors take measures to protect clients from “serious and foreseeable harm.” See Standard B.2.a. of the 2014 ACA Code of Ethics.)

“It’s not ever my job to diagnose someone I don’t know and those who aren’t a client of mine,” Lucci says. “But I can listen and hear the behaviors described by the client and how it’s affecting them. Then, we focus on how [the client] can deal with those behaviors. I don’t ever want to assume how someone is feeling or what’s going on. … Most of all, I want people to feel connected and come to decisions about change on their own.”

Counselors can also equip clients in these situations with resources and serve as support while they decide what they want the relationship to look like, Ohlund adds. But this work will take patience on the part of the counselor, she notes.

“As a counselor, sometimes we can see really far ahead. We can see really clearly what needs to be done in a situation, but it may take a client a very long time to get there,” Ohlund says. “Sometimes it’s easy to feel frustrated: Why can’t they see [it]? Why do they keep these patterns?” 

She advises counselors to be patient and not feel like they are doing things wrong. Instead, “be assured that you’re doing all you can to support a client, and that’s what they need — they may have never had that in their life,” she says.

Similarly, Collier feels her role is to sit with clients and ask questions to help them explore emotions and come to realizations about their situation. Her focus is on the process rather than the symptoms that bring clients into counseling. “I’m interested in how the person is thinking about the problem and the challenge, what has worked and what hasn’t worked, what they’ve tried and how they understand it,” Collier says.

Counselors also need to work through relationship struggles in their own lives to better support clients who are seeking help for similar issues, Collier stresses.

“The client’s ability to change and really think about their situation is only going to be as good as that person who is sitting in the room with them and their ability to see and think about situations,” Collier says. “Our level of maturity lends itself to what will really help a person, and that comes from really examining relationships and patterns in our own lives. That is above and beyond any technique or anything that I can do with a client. We all have problems in our own lives and our relationships, and we need to work on those so we can help clients and think objectively.”

 

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Bethany Bray is a senior writer and social media coordinator for Counseling Today. Contact her at bbray@counseling.org.

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Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

Master conflict therapy as a critical component of couples and sex therapy

By Heather Davidson March 4, 2021

“We just don’t communicate well,” Merle reported in our first session while her husband, Luke, nodded quietly in agreement. Like many couples presenting for couples counseling, Merle and Luke believed “communication issues” were causing much of their relationship distress.

As a couples therapist, I knew that “communication issues” could mean myriad things. As is the case with many couples I see, I found that Merle and Luke were actually communicating well with each other. The conflict seemed to have more to do with the fact that they did not like what the other was saying.

The distress that Merle and Luke were experiencing in their relationship was affecting their sexual relationship too. When it comes to couples, whatever issues are going on outside of the bedroom also play out in the bedroom. Recent research shows that 40% to 50% of women (Marita McCabe et al., publishing in The Journal of Sexual Medicine in 2016) and 31% of men (Cleveland Clinic, 2016) experience a sexual disorder. The research suggests that even if couples initially report a nonsexual problem such as communication issues, they are likely experiencing sexual difficulties as well.

Despite how common sexual issues are, many counselors are uncomfortable discussing sexual matters with their clients. Counselors who fail to ask about a couple’s sex life, even in cases in which couples are presenting with the generic complaint of communication issues, are neglecting important information that would help them develop a deeper understanding of the couple. The therapist who disregards the sexual aspect of the couple’s relationship will struggle to help the couple achieve a healthier level of functioning.

As both a couples therapist and certified sex therapist, I believe that a couple’s sexual dynamics can tell us a great deal about their nonsexual dynamics and vice versa. Master conflict therapy has provided me the skill set and ability to go deeper with couples who present with a wide variety of relational and sexual problems.

Identifying the master conflict

Master conflict therapy is an integrative approach to treating couples that combines Freudian psychoanalytic conflict theory and Bowen theory with basic principles and practices of sex therapy. We each have a master conflict and unconsciously choose a long-term partner with the same master conflict. The master conflict stays with us for life, regardless of whether we stay with our long-term partner. The goal of master conflict therapy is for couples to learn how to healthily balance and manage their master conflict, because it will never go away.

A couple typically has the same fight over and over again. While the content of the fight may change, the process of the fight looks the same. For instance, Merle and Luke fought often about how to spend their money, how to spend their free time and even how often they should visit their in-laws. But the process of their fighting was that of two partners vying for the other’s acceptance while simultaneously rejecting each other. The process of the fight can sometimes be a good indicator of what the master conflict is.

Counselors should familiarize themselves with several important facts about master conflicts. First, master conflicts are internalized in childhood by verbal and behavioral messages from one’s family of origin. The master conflict can be influenced by religion, culture, ethnicity or experiences of traumatic events in childhood. Commonly, clients are aware of one side of their conflict, but rarely are they aware of both. Clients might have multiple conflicts, but the master conflict is the most influential or most powerful. In addition, the master conflict is evident is many areas of the client’s life (work dynamics, career choices, friendships, hobbies, etc.). It is also important to note that neither side of the conflict is better than the other. Rather, both sides of the conflict have pros and cons.

Although master conflicts do not influence who we choose for short-term relationships or casual sexual encounters, they do determine the choice of a long-term partner. Long-term partners will share the same master conflict. Master conflicts are normal and exist in every relationship. However, when the conflict becomes unbalanced, the couple will find themselves in distress. Once the master conflict becomes unbalanced, it can be very difficult for the couple to manage. Ultimately, to balance the master conflict, both partners must agree on a strategy and work collaboratively to manage the master conflict.

Many events can unbalance a master conflict, including major career changes, financial changes, a new baby or even living with your partner in quarantine during a global pandemic. For Merle and Luke, problems had been brewing for some time, but the crisis of quarantine unbalanced their master conflict of acceptance vs. rejection. Those with an acceptance versus rejection conflict have one side of themselves that needs to be accepted and another side that needs to be rejected. Merle and Luke both desired to please others and had a strong desire to be accepted by the other. Paradoxically, those with this master conflict also unconsciously set themselves up to be rejected by others.

In our book Master Conflict Therapy: A New Model for Practicing Couples and Sex Therapy, published in 2018, Stephen Betchen and I outline 19 of the most common master conflicts we see in our clinical practices. In addition to acceptance vs. rejection, another very common master conflict that I see is commitment vs. freedom. Clients with this master conflict have one side that wants stability and the security of commitment, but the other side longs to be free of restraints. People who have a history of affairs or a pattern of quickly getting in and out of relationships may be likely to have this master conflict. Clients who witnessed their parents’ affairs or demonstrated lack of commitment to each other may also develop this master conflict. Those with this master conflict may have patterns of changing careers or jobs often, moving frequently or getting involved in many different hobbies or interests without pursuing any of them long term.

Counselors who work extensively with addictions should become familiar with the getting your needs met vs. caretaking master conflict. For this master conflict, one side of the client wants to meet their own personal needs, while the other side desires to be selfless and martyrlike. Clients who have this master conflict often were raised in families in which addiction was present or a parent or sibling had a disability or illness that required most of the family’s attention and resources. These clients often have specific life goals that they would like to achieve, but their martyrdom at work, in friendships, and with their families and significant other consumes most of their time and energy needed to meet these goals.

Another common master conflict is specialness vs. ordinariness. Clients with this master conflict have one side that needs to feel special or different, while the other side feels ordinary or even less than ordinary. The client who builds themselves up while simultaneously putting themselves down could have this conflict. People with this master conflict seek constant validation and pursue materialistic possessions or unique life experiences that they believe make them different. Those with this master conflict are at higher risk of engaging in affairs because affairs are an easy way to experience the high of being “special.” Despite the constant chasing to set themselves apart from the crowd, people with this master conflict continue to feel as though they are “less than” or just ordinary, often because what they have built their specialness up from is not authentic.

Counselors who work with high achievers, including those at the top of their professional fields, celebrities and elite athletes, should look out for success vs. sabotage. Clients with this master conflict want to be successful or big and often have achieved something major, but the other side of themselves desires to be small or to fail. With great success comes the risk of great failure. Individuals with this conflict will sabotage their own success, and because their partner shares the same master conflict, their partner will also sabotage them if they become too big or too successful. 

Assessment and development of relationship symptoms

The first three to five sessions should serve as the assessment phase of treatment. While I let couples start where they need to in the first session, during the next few sessions I collect a genogram and history for each partner. As I gather this information, I also pay attention to both the language they use to describe their presenting problems and to their nonverbal communication.

Merle often used the word “rejected” and described her position in the relationship as “unfair.” She tended to be the more vocal and active partner in couples therapy. Luke, on the other hand, presented as distant and seemed shut down or dismissive toward Merle. Luke reported that “Merle just does not like what I value,” and I observed resentment in many of the passive-aggressive comments he would make toward Merle in session.

The couple explained that they were seeking couples therapy because of “bad fighting and poor communication” since being quarantined with each other. Some of the fights were related to sharing household tasks and parenting while still trying to work. But the major source of conflict concerned whether now was an appropriate time to try having a second child. Luke believed the couple should delay or not even have a second child because of the economic instability associated with the global pandemic. Merle accused Luke of being “selfish” and concerned merely with having time to pursue his artistic interest (an interest with which he was experiencing success).

The couple reported meeting as young 20-somethings at work. They both described the dating and engagement phase of their relationship as positive. At the time, Merle was supportive of Luke pursuing art, and in turn he supported Merle going after her dream career even though it was in a low-paying field. Although the young couple had always planned on having a family eventually, they were surprised to learn a few months before their wedding that Merle was pregnant. They both cited the unplanned pregnancy as the beginning of their relationship’s demise, but they each had different beliefs as to why that was.

Merle came from a warm but intrusive family. She described having close relationships with her sisters. She had excelled in school and sports as a child and teen. Merle described herself as a “people pleaser,” and she often worried about disappointing her family and friends. When one of her sisters dropped out of college to pursue a different career path, Merle saw her parents struggle deeply with that decision. Merle’s father was a first-generation immigrant who had never had the opportunity to go to college. It was very important to him that all of his daughters complete college, and Merle believed that he never fully recovered from her sister’s decision to leave school.

When Merle discovered she was pregnant before her wedding, she was so terrified to disappoint her parents that she concealed the news until after the event was over, even though it was obvious that she had gained weight. As Merle explained, “I would rather deal with my parents’ disappointment about me getting fat than their disappointment in me getting pregnant before being married.”

Luke came from a disorganized and controlling family. Both of his parents came from working-class backgrounds and were religiously conservative. Although Luke had an interest in pursuing the arts, both of his parents prohibited him from getting involved in such an “impractical” interest and pushed him into activities that were “better for getting into college,” even though he had little interest in them. Luke was also deaf in one ear, which had created learning difficulties for him as a young child. This was another trait he felt made him “less than” his other siblings. While his siblings followed in the path of their religious parents, Luke showed little interest in organized religion and eventually left his parents’ faith as a young adult. This decision caused much conflict within the family.

As the third child of seven, Luke had often witnessed his mother being overwhelmed by their large family, especially given that her husband worked long hours to support them. Luke described feeling robbed of what he perceived to be normal childhood pleasures and experiences due to his parents’ inability to provide adequate attention and financial support to their children.

Luke had spent much of his 20s getting his professional day job to a place where he was secure and could devote more time to pursuing his artistic interests, which his parents continued to disapprove of from a distance. Although Merle tried to reassure Luke that their baby would not change his ability to engage in his artistic pursuits, he knew from his own childhood that this simply was not true. Luke described a period of depression during the pregnancy. Merle reported being excited about the pregnancy but also stressed about how to “make Luke be OK with it.”

During the assessment, I always take a sexual history. In this case, both partners denied experiencing any sexual trauma, and both reported having long-term relationship partners before they met each other. Luke acknowledged being less sexually experienced than Merle due to his upbringing. Despite this, the couple felt positive about their sexual relationship before having a child; they were both happy with the frequency and believed they shared mutually in pleasure. In recent years, however, their sexual frequency had declined. Luke attributed this to stress, whereas Merle worried that it was more personal.

Discussing a couple’s sexual development and history helps the counselor to recognize sexual patterns. It also helps the couple become more comfortable talking about sex. Merle eventually disclosed tearfully that she worried Luke was no longer attracted to her because he experienced delayed ejaculation. Luke claimed to be unsure about why he was experiencing this problem and denied that he was no longer attracted to Merle. Both reported that the delayed ejaculation began around the same time they were fighting over whether to have a second child.

In treatment, Luke eventually admitted feeling conflicted about having a second child and worried that the additional demands would take away from his pursuit of a side career as an artist. Merle dismissed his concerns as selfish and lashed out at him for “taking away” her dreams of a larger family. Living under quarantine caused Luke rarely to have time to do anything with his art. In fact, he spent most of his time balancing working from home and trying to parent. The result of these sexual experiences left both partners feeling rejected by the other: Merle by Luke’s delayed ejaculation and lack of desire for another child, and Luke by Merle’s reaction to his sexual difficulty and overly optimistic stance on having another child.   

Treatment and relapse prevention

Master conflict therapy consists of four treatment goals:

1) To help the couple uncover their shared master conflict

2) To help the couple determine the origin of their master conflict

3) To help the couple decide which side of the conflict to choose, or to integrate both sides of the conflict to a tolerable, balanced state

4) To alleviate the couple’s symptoms, both sexual and nonsexual

Couples should leave treatment knowing how to manage their master conflict, which will prevent a relapse when their conflict becomes unbalanced in the future. Their fighting should become less intense and less frequent, and they should have the skills to collaboratively manage their master conflict.

It takes many sessions to fully understand a couple and to gather enough data to support whatever master conflict a therapist might suspect. During this time, the therapist should be conducting a thorough assessment, providing the couple with relevant psychoeducation regarding their presenting problem, and providing the couple with behavioral strategies that can help them get out of crisis.

With Merle and Luke, I discussed psychoeducation regarding delayed ejaculation and sexual desire. I also helped the couple improve their basic communication skills. Because Luke did not have any medical risk factors that would have caused delayed ejaculation (we ruled these out with an extensive medical history, a visit to a urologist and routine bloodwork), I suspected most of the problem was psychological. I also explored with the couple the behaviors and emotional baggage that each of them brought to the relationship from their families of origin that not only informed their conflict style, but also colored the way each of them viewed this conflict.

Merle and Luke soon began to see the ways in which they were similar, including both never feeling fully accepted by their families and both fearing rejection by the other. They eventually recognized the ways that their own acceptance vs. rejection master conflict played out in other areas of their life unrelated to their romantic relationship. Merle had a long history of people pleasing and a yearning to be accepted by female friends; this often set her up for disappointment and rejection. Luke was a hard worker and longed to be acknowledged at work, but when he did receive praise, he would act out, leading his superiors to feel frustrated with him. Discovering how similar they were to each other helped Merle and Luke to build mutual empathy.

Once this couple gained a better understanding of their master conflict and the impact it had on their lives, we turned to the issue of having a second child. Merle felt conflicted between wanting to please Luke by limiting the family to one child and wanting to expand the family, even if this meant additional challenges for them and more tension between them. Luke saw Merle as willing to risk their relationship, their financial stability and the overall stability they had created for their first child just to have another child. He explained that he worked hard in a day job that he did not particularly like and put his artistic pursuits to the side for the sake of family stability. This had also enabled Merle to take her “dream job” even though it was low paying — something the couple agreed on during their engagement.

After much processing, Luke expressed that the only way he would agree to having a second child would be if Merle took a higher paying job or they found a way to move to a much more affordable area of the country. Faced with the idea of losing her career, Merle was better able to resonate with Luke’s position. Ultimately, the couple decided to shelve the decision to have another child for one year. Merle would explore other career opportunities that could provide the family with additional financial security, while Luke agreed to look for affordable places that the family could live and examine whether a more permanent work-from-home situation might ever be available to him.

Upon termination, the couple reported fighting much less frequently and with less intensity. They reached an understanding of their master conflict and could now easily predict where each of them might struggle or feel triggered by the other. As they had resolved their conflicts, gained more understanding over their pattern of fighting and mutually agreed not to have another child at this time, Luke’s delayed ejaculation subsided. Merle’s fears of not being attractive to Luke waned, and the couple both reported feeling more emotionally and sexually connected.

Master conflict therapy prepares couples to manage their differences and conflicts for the long term. By providing a framework for better understanding themselves and each other, the couple can better manage future conflicts — regardless of the content — as they see how the process is the same.

 

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Heather Davidson is a licensed professional counselor and the founder/owner of a boutique private practice in Bryn Mawr, Pennsylvania, called Better Being Main Line. She is both a certified sex therapist and a certified eye movement desensitization and reprocessing therapist and specializes in treating individuals and couples with sexual issues and those with traumatic experiences. She is the co-author of the book Master Conflict Therapy: A New Model for Practicing Couples and Sex Therapy (Routledge, 2018) and is an instructor for the Council for Relationships’ postgraduate certificate program in sex therapy. Contact her at heatherdavidsonlpc@gmail.com.

Knowledge Share articles are developed from sessions presented at American Counseling Association conferences.

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Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

Gone but not missed: When grief is complex

By Bethany Bray January 27, 2021

The aphorism “do not speak ill of the dead” is attributed to the philosopher Chilon of Sparta. First written in Greek and later popularized in Latin, De mortuis nihil nisi bonum, the phrase perpetuates a social taboo against criticizing someone who has died.

Centuries after it was first uttered, clients in counseling may still hesitate to “speak ill” of someone in their life who has died. It’s natural, however, for human grief to involve a range of thoughts and feelings — not all of which will frame the deceased in a positive light. This is all the more true when the person who died had an abusive, rocky, strained, unsupportive, toxic or absent relationship with the client.

“Having conflicted feelings about the deceased happens more often than is discussed,” says Elizabeth Crunk, a licensed graduate professional counselor who specializes in helping clients with grief and loss at her private practice in Washington, D.C. “There’s a societal expectation that we don’t speak ill of the dead, and I think that sometimes can keep people even from seeking counseling.”

That hesitancy can be compounded when the client is worried about how a counselor might react to their situation. It isn’t uncommon for clients to assume that a practitioner will judge them negatively or expect them to forgive the deceased if they are struggling with mixed feelings about the person’s death, Crunk explains.

“It’s important [for counselors] to validate those coexisting feelings. It is possible to feel both sorrow and joy,” Crunk says. “Also, it’s important to validate [a client’s] feelings of numbness or not feeling sad. Assure them that they don’t necessarily need to conjure up sadness if that’s not genuinely what they feel.”

It’s complicated

The emotions that clients experience in response to the death of a person with whom they had an unhealthy relationship are certainly complicated. However, the term complicated grief is a specific psychological diagnosis (also called prolonged grief disorder) that involves lengthy, extended grief that often is accompanied by intense emotional pain and longing for the deceased, as well as maladaptive behaviors such as disbelief that the person actually died. (For more, see our 2014 article “The complicated mourner.”)

It is possible that clients who have lost someone for whom they have mixed feelings will experience complicated grief. However, Crunk says, the experience is perhaps more likely to fall under the definition of disenfranchised grief — a type of grief that is unsupported or unrecognized by society or culture.

Clients who don’t feel “sad” in the traditional sense about a death may believe that their experience is not socially acceptable. Such mixed feelings can be especially common when the death has a certain stigma attached to it, such as with deaths due to suicide or drug overdose, says Karin Murphy, a licensed professional counselor (LPC) who specializes in grief work at her Doylestown, Pennsylvania, private practice. Counselors who work in the addictions field or with clients whose loved ones battle addiction may hear clients disclose these types of feelings, she notes. Regardless of specialty, counselors may encounter clients using language that minimizes their loss (even when they feel the loss acutely) if they sense any stigma connected to the person’s death.

“It’s really important for counselors not to perpetuate that disenfranchisement. [A client’s grief] is supported, recognized and valid,” Murphy says.

The disenfranchised grief these clients experience “doesn’t allow room for them to express the range of what they’re feeling — especially relief,” adds Crunk, a member of the American Counseling Association and a courtesy assistant professor in the counseling department at George Washington University in Washington, D.C.

Such circumstances can spur conflict even within family networks, Crunk says. One or more family members may have had a good and loving relationship with the deceased, whereas other members of the family may not have. In these cases, family discussions about how, or whether, to memorialize and remember the deceased can be fraught with tension.

The death of a parent, spouse or other person who was abusive, neglectful or invalidating toward a client can result in a grief process that is difficult for others to understand or accept, says Mark Tichon, an LPC who is an associate professor and counseling program director at Lincoln Memorial University in Tennessee.

“The relief that can accompany the passing of an abuser is hard to discuss without seeming callous,” says Tichon, a member of ACA. “In these cases, strong contradictory feelings of longing for a [healthy] relationship and the burden of guilt at the sense of relief may result in a grieving process that is marginalized and not socially validated.”

Related emotions

Clients who seek counseling for a range of issues could be struggling with this type of unprocessed grief without being able to name it or disclose it themselves at intake. Counselor clinicians can listen and watch for a number of emotions that commonly dovetail with struggles over the loss of a person for whom the client had a complicated or unhealthy relationship.

In Murphy’s experience, shame, relief and guilt are most commonly expressed by these clients. Feeling a sense of relief that a person is gone often causes clients to question what that means about them.

“It’s feeling release, but [clients] have a very difficult time naming that. ‘What does that say about me if I’m relieved that this person has died?’ And with that relief comes shame,” Murphy says. Clients may struggle with, “What’s my part in this? What did I do to contribute to this sense of unfinished business? And the would haves, could haves, should haves that come from that.”

In addition, Crunk notes that these clients may express self-blame, anger, numbness or ambivalence over the loss. They may grapple with feeling unsettled or unresolved about certain aspects of their relationship with the deceased. They may feel grief centered not on the loss of the actual person but on the loss of a relationship that never was or of what might have been, Crunk adds.

Murphy urges counselors to remember that complicated feelings can also occur when clients experience nondeath losses, such as a change in someone who is no longer themselves because of dementia, addiction, chronic illness or other conditions. A conflicted relationship does not go away when the person begins to change because of illness, she points out. In fact, clients’ emotions may be exacerbated if they are pushed into a caregiving role.

“Understand that loss may not involve death. Life is really a series of losses, but a lot of times we don’t think about grieving, or giving ourselves permission to grieve, unless there’s been an actual death of a person,” says Murphy, who is certified in thanatology and has past experience as a hospice bereavement coordinator. “A lot of times, we have feelings about things, but we’re not really told or given space to understand that not only is it OK to feel that way, but we might expect to feel that way. That’s where the disconnect happens — feeling too much or too little. And that’s what brings [people] into counseling.”

In session, Crunk begins to explore the client’s feelings surrounding their loss with questions about the relationship the client had with the deceased. She asks the client to describe what life with the person was like. If there is any indication of conflicted feelings on the part of the client, she follows up with more gentle questioning.

“I ask them early on to talk about their relationship with the person [who died]. I try to open the door a little bit for them to share if there is some ambivalence. I don’t want to push that too hard but [simply] open the door. I want to assure them that they don’t have to speak positively all of the time,” Crunk says. “Even with deceased loved ones that we had a good relationship with, there are always aspects that we didn’t like, or things we didn’t agree with. I always try and leave room for that side of the coin.”

“Sometimes what comes up too is that we start our work and the client thinks that they had a pretty positive relationship [with the deceased], but as we begin to dig deeper into the story, other more complicated aspects arise,” adds Crunk, who co-authored a 2017 Journal of Counseling & Development article, “Complicated Grief: An Evolving Theoretical Landscape,” with Laurie A. Burke and E. H. Mike Robinson III.

This was the case with one of Crunk’s clients who grew up with a mother who was abusive. In counseling, the client needed help processing the death of her father. At first, the client identified her father as a protective figure, but as she worked through the loss in counseling, she began to voice feelings of disappointment that her father hadn’t done more to remove her from an abusive situation. At that point, Crunk recalls, their counseling work shifted to processing the client’s newly discovered feelings about her father.

Grief has many layers, but that is especially so for clients who have conflicted feelings, Tichon says. “One thing clients may need to do with a compassionate and humanistic counselor is grieve the loss of having an ideal parent, for which many clients hold hope as they grow older, or grieve the loss of hoped for reconciliation that will never come.”

Tichon once worked with a man who struggled acutely with the loss of what could have been. The client’s father, who had narcissistic personality traits, died “just as their relationship was starting to become more of an adult friendship where [the son] could exert healthy boundaries that allowed him to genuinely enjoy their time together,” Tichon says. The client’s father had died suddenly, so there was no chance to say goodbye or find closure.

“It took a long time for him to reconcile the conflicting emotions of sadness over the death of his father with the feeling of freedom from parental judgment and punitive emotions,” Tichon says. “One key goal of therapy was for this client to resolve feelings of guilt over the relief that his dad was no longer in his life. At the end of our time together, this client was able to say thoughtfully, ‘I still miss him, but I’m also relieved he’s out of my everyday life for good’ with a sense of peace.

“The tension between feelings of loss over what could have been a meaningful adult relationship, anger and resentment over emotional neglect during his childhood and adolescence, and guilt over feelings of relief that the relationship was finally over had resolved to … greater clarity and peace as he became more fully accepting of these intense and contradictory feelings.”

Unwrapping

Grief work should always be tailored to the specific needs of the client, but that becomes especially important with those who are navigating mixed emotions about the deceased. As a counselor who specializes in grief and loss, Crunk may have five clients who are experiencing the same type of loss — the death of a parent, for example. But as Crunk points out, each client will have different aspects of the loss that they struggle with and need to process.

To narrow the focus, Crunk encourages clients to identify what is “most troubling” to them about the loss. If the loss was traumatic or unexpected, that may be the aspect that is most troubling to them, she explains. But for other clients, it could be feelings of guilt or shame surrounding a person’s death.

One of Crunk’s clients was mourning the loss of her grandchild. The client had experienced a troubled upbringing herself, but as an adult, she had endeavored to create healthy and safe family dynamics for her own children and grandchildren. As their work in counseling progressed, it became clear that the client was grieving the loss of her identity as a loving grandparent as much as the death of her grandchild.

“I had assumed that losing her first grandchild was the worst of it. But when I asked her what was the most painful, she said, ‘I worked really hard to cultivate a healthy, stable life, and now I’ll never have that perfect life.’ She had lost that part of her narrative: She no longer had a ‘perfect’ life,” Crunk recalls. “It’s important [for counselors] to put personal assumptions aside. What you assume is the most troubling [aspect] may not be. Let the client dictate, and spend the most time on that.”

Helping clients give voice to the complicated feelings that accompany a loss is among the most important things that a counselor can do, says Tichon, who is scheduled to co-present a session, “Complicated Grief: Treatment Stories and Experiential Exercises,” at ACA’s Virtual Conference Experience in April. Tichon has past experience as a geriatric counselor and would sometimes hear clients express a range of feelings that they had held on to for years regarding a loss.

One client, a woman in her 80s, had lost her husband two decades prior but still harbored resentment because he had been emotionally punitive, controlling and physically abusive early in their marriage. In counseling, she needed to process both the loss of her husband and the pain he had caused her.

“She grew up in an era when people often did not discuss their marital problems outside of the home. At the beginning of addressing this topic in therapy, she had a lot of guilt and shame about ‘talking bad about him,’ as she had some religiosity about needing to honor her husband,” Tichon recalls.

As their counseling work progressed, the client grew in her ability to verbalize her feelings of hurt and sadness and, in turn, process the abuse her husband had perpetrated. Only then was she able to focus on some of the more positive feelings she had toward her husband, Tichon says. As a result, her depressive symptoms lessened, and her life narrative became much more positive.

“He had been dead for 20 years, but her unexpressed resentment had [been] pent up in her all those years. … She made a breakthrough in the process of grief when she was able to voice that although the physical abuse had ended when she was in her 30s, she held contempt and emotional distance [for her husband] through the end of the marriage. At 83 years old, she wound up owning her own part in a bad marriage, and in a faith-based, spiritual way, asked for forgiveness for not accepting his remorse and validating that, in some ways, he was a changed man [while] he was still alive,” Tichon says. “In short, grief needs to happen, and when we allow the depth of the process to work through in what is often long-term therapy, we deeply heal.”

Making meaning

Expressive therapies can be particularly useful in helping clients make meaning of losses that involve mixed feelings. Exercises such as writing a letter to the deceased can be especially helpful when clients feel that things were left unfinished or unhealed in the relationship. However, work should be client led, and interventions must be used only when appropriate.

“Writing a letter to the deceased person — highlighting the happy moments, the resentment, anger and sadness that the relationship caused, and unrealized dreams and hopes — and reading that letter using empty chair work can help integrate these emotions into the personality,” Tichon says. “I find that when using the empty chair technique, if I have the client mindfully visualize the person sitting there, down to remembering mannerisms and clothing of the object of their grief, it makes the experience particularly impactful. I would rule out this depth of visualization, however, if the deceased was particularly abusive. I would not engage the client in this level of visualization of the abuser, as the intervention is significantly deep. In cases like this, venting strong emotions and giving voice to unresolved anger and hurt is, in itself, very cathartic.”

Bernadette Joy Graham, an LPC who specializes in grief and loss at her Maumee, Ohio, private practice, uses a similar technique, prompting clients to use their imagination to create a space where they can visualize meeting the person who died and speak with them to find closure. This can be a real place, such as a room in their childhood home, or a setting that holds meaning for the client. Graham lost her mother when she was a teenager, and she uses this technique herself, imagining a front porch where she can sit down with, see and speak with her mother whenever she feels the need to.

Crunk also uses various correspondence exercises, including letter writing, journaling, the empty chair technique and other imagined dialogue techniques, with her clients. She says this work allows clients to say things they wish they had said while the person was still alive, apologize if they feel that is needed, work through complicated emotions and process unresolved conflict.

“The end goal is about revising their self-narrative and their narrative of the relationship with that person that brings a little more repair and helps things feel a little bit more integrated,” Crunk says. “I use a lot of attachment-informed meaning reconstruction techniques to help them create a coherent grief narrative.”

In sessions, she also looks for nonverbal cues that might indicate that a client needs to explore something further. If a client shows signs of agitation, for example, she’ll ask them to name what they’re feeling.

“If I see tears, I ask, ‘If these tears could talk to you, what would they be saying?’ If they say, ‘I feel a heaviness in my chest when I talk about this person,’ I might ask them to put a hand on their heart, and I might mirror that with my own hand,” Crunk says. “Then, I’ll ask them to describe that heaviness. Does it have a shape? Does it have an image? It’s all with an aim of them being able to tolerate that.”

Crunk is using telebehavioral health with her entire caseload during the coronavirus pandemic and acknowledges that picking up on nonverbal cues from clients can be more challenging. However, she believes that “it’s all the more important to show that I’m present, that I’m there with them, offering a place to cry or feel anger or relief, whatever it is.”

Some grief counseling techniques may need to be adjusted slightly when used with clients who did not have a good relationship with the deceased, Crunk notes. This is the case with empty chair, letter writing and other expressive techniques. The goal of these techniques is not to have clients reimagine their narratives regarding the person — for example, by pretending that the abuse never took place or that the person never lapsed into addictive behaviors. Rather, the goal is to help them reconstruct their narrative of their relationship with that person and, potentially, accommodate any new insights about the person who died or their relationship with that person into their current awareness or schemas. Sometimes, Crunk explains, when “conversing” with the person who died, the client stumbles upon a new insight about that person or their life that helps the client see their relationship with that person from a different perspective — one that can potentially help the client make more sense of their loss or bring them some calm.

These techniques are meant to offer clients a pathway “to revise the relationship in a way that they can carry it with them but that does not put pressure on the client to transform it into something that is unrealistic or fictional,” Crunk explains. “It helps the client imagine a world where there is an opportunity to receive an apology or hear words that they yearned to hear the person say.”

Clients sometimes express doubt about whether the deceased person loved them or struggle with things that went unsaid or undone while the person was alive, Murphy notes. She urges counselors to help clients find creative ways of expressing or completing what was “left undone.” For instance, counselors can leverage anything that a client enjoys as a hobby — writing poetry, painting, making collages — to help them communicate thoughts that are uncomfortable or to explore things that went unfinished between themselves and the deceased.

The simple act of writing down a thought, even if it gets tucked away in a desk drawer or journal, validates what the client is feeling and acknowledges that they are working through it, Murphy says. She sometimes recommends that clients read licensed mental health counselor Stephanie Jose’s book Progressing Through Grief: Guided Exercises to Understand Your Emotions and Recover From Loss, which features journal prompts throughout the text.

“Getting the thoughts and feelings out of your head and having a container for them is going to bring relief. It allows clients to process these feelings but also separate themselves from them and put them in a separate place than their mind,” Murphy says. “There is a common misconception: If I just give it enough time, I’m going to feel better. In reality, it’s time plus what you do that will help.”

In addition to encouraging expressive therapies, Murphy often suggests that clients seek out grief support groups so that they can connect with others going through similar experiences. Doing volunteer work can sometimes help clients address things that they feel they didn’t accomplish with the person who died, she adds. For example, they may not have been able to reconcile with an older relative before that person passed away, but they can forge connections with other older adults by volunteering at a nursing home or similar setting.

Similarly, counselors can help clients create new rituals to mark the passing of someone for whom they have mixed feelings. This can be done privately on their own, or with the practitioner in session. It can involve anything from making a donation to a cause that is important to the client or was important to the deceased, to eating at a restaurant that the client associates with good memories about the deceased.

Tichon agrees that expressive and creative therapies can be particularly helpful with clients who are “stuck” or need to process hurtful feelings regarding a loss. In one technique, Tichon has clients rip off a piece of paper for each emotion or painful memory that they express in session regarding the deceased.

“At the end of this exercise, the client is often in tears and staring at a shredded pile of paper, deeply in tune with the feelings of pain and brokenness. We then process how this piece of paper won’t look like what it did before we started, but we can use it to build something new. And in grief, things won’t be the same [either], but they can be good again,” Tichon says.

Tichon then directs clients to take their shreds of paper home and use them to create something that speaks to their hopes for the future. “This has been a particularly powerful experiential intervention, and clients have brought back art and murals that serve as metaphors for moving forward and building new meaning in life,” he says.

Leaning in

Counselors might find themselves experiencing the urge to comfort clients who are struggling with difficult emotions related to the death of someone who inflicted pain upon them, Crunk notes. While these clients need support, they also need to gradually work through the discomfort they feel regarding the loss.

“Grief, as painful as it is, it’s my belief that it needs to be felt. It can become complicated, but in general, for the vast majority of people, it’s not a disorder. [It’s] an emotion that needs to be felt and honored. I try and create a space for the person to emote and hold that grief [in a] container for them. I don’t want to press too hard, but I encourage them to lean in to it, to be able to expand their tolerance and sit with their grief,” Crunk says. “It’s a delicate balance because, as much as I want to provide comfort, if that’s all that I do, then nothing will change. … We want so badly to help [our clients] and provide support and comfort. It can feel counterintuitive in grief counseling, but sometimes the most helpful thing to do is to help them increase that capacity to feel their grief. As painful as it is, it’s a necessary part of healing.”

That delicate balance involves helping clients access and sit with their feelings of grief and find ways to take respite from their grief, pursue restoration or give themselves permission to feel positive emotions, Crunk adds.

Clients who are struggling with a painful, complicated loss sometimes ask how soon they will feel better or get through it. Making promises to these clients that everything will eventually be fine is not appropriate, Graham asserts. Although it is natural for counselors to want to “fix” these clients, practitioners must push back against that urge, she says.

“Be honest with the client and say, ‘This will never be easy, and you might never have [complete] closure,’” Graham advises. “I give them as much support as possible, but I never say, ‘It’s going to be OK.’ I say, ‘I don’t know how long this will take. Everyone’s different and everyone’s unique. There is commonality in grief, but no two experiences are the same.’”

Murphy acts as a gentle guide for clients as they lean in to their uncomfortable feelings related to grief. “I often tell clients, ‘We’re doing this in bite-size pieces … because it’s too big to do all at once.’ I hear this a lot from my clients: ‘It’s been three months, and no one wants to hear me talk about this [anymore]. Why aren’t I over it?’ A lot of [this] is realizing that grief has no timeline.”

Murphy says clients often need to give themselves the following permission: “I have every right to grieve this. It matters to me, and it’s going to take as long as it takes.”

Instilling self-compassion and focusing on self-talk can make an important difference for clients struggling with disenfranchised grief, she says. “Finding the self-compassion to sit with what you need to allows you to move past it,” Murphy says. “I often hear from clients, ‘If I let myself cry, I’m never going to stop.’ I [say to clients], ‘Let’s test that out. When was a time when you allowed yourself to feel something, and did that last forever?’ It’s a lesson that feelings come and go, but they’re not here to stay.”

Forgiveness and compassion

Clients who harbor feelings that go against cultural norms — such as feeling relief that a family member has died — need a safe space to voice those feelings. Tichon urges counselors to “wear their best Carl Rogers hat” when working with these clients and to remember the principle of unconditional positive regard.

“Allowing the client to experience the full range of conflicting emotions, and providing the depth of a supportive, nurturing and nonjudgmental environment — which the client often has not experienced — can allow deep healing to occur. … Clients may have feelings of longing and sadness, but also betrayal, anger and contempt. It is helpful to extend compassion and allow clients to explore and express the fullness of those conflicting emotions and grieve the loss of the ideal parent, spouse or significant attachment figure who they never had. [This can result] in validation of feelings [that are] contrary to cultural messages on grieving.”

Murphy also emphasizes the need for practitioner compassion with these clients. “Maybe they’ve never had anyone ask them how they’ve felt about the loss. That can go a long way, and it opens the door to get them to talk about it,” Murphy says. “Validation [of the client’s feelings] is the important first step.”

“A big concern [that clients voice] is ‘What’s wrong with me? Why am I feeling this, and why can’t I get over this?’ And the answer is because you’re human,” Murphy continues. “When we’re doing this type of work, the relationship — that therapeutic alliance — is the most important. We can talk about tools, but the most important thing is that the person is feeling heard and acknowledged. … What we [counselors] can bring is to be present during that pain and allow the space [to process it]. That’s what it’s all about: Just being validated is the most important thing, and then figuring out from there what tools are needed, because it’s so individualized.”

Graham says that “empathy goes a long way” with these clients and also stresses the need to keep the work client led. Prior to intake, she explains to clients that the assessment process will take the entire session and that she will be asking about subjects that may stir up difficult feelings. “Don’t assume that they know what assessment is and how it works,” Graham says. “They may not realize that they’re going to have to disclose past trauma, assault” or other painful issues.

A gentle approach on the part of the counselor can prevent clients’ anxiety from spiraling, Graham says, especially if they aren’t familiar with the therapy setting. This can mean the difference between a client returning to counseling or dropping out, she says. “I tell the client, ‘There will be a lot of serious questions that are going to take you back in time. If it gets too emotional, we can stop and take a break,’” says Graham, who previously worked at an inpatient rehabilitation center for clients with substance dependence. Graham also stays mindful during sessions and steers the conversation to lighter topics toward the end, while leaving time for questions from the client. If appropriate, she finishes with a joke to get the client laughing. “They are going to have to go home and function [after session],” Graham says, “[so] I try and close the wound back up a little.”

Another aspect of this work with which counselors must tread lightly is the issue of forgiving the deceased, Crunk says. This too must be client led. Forgiveness is sometimes an outcome of grief counseling, but it should never be imposed by a counselor, she stresses.

“I would never pressure a client or use that type of language unless they bring it up. If, through the work, they find more compassion or empathy toward the person, [that can be a positive outcome], but I just don’t feel that should come from me. It’s not a goal that I would impose on the work,” Crunk says. “There are ways that positive psychology can lead to growth and positive outcomes, but we also have to be careful how we use them. Clients can react, understandably, negatively if they feel their counselor is trying to get them to find beauty in their grief or goodness in their relationship. We have to be careful that it doesn’t feel forced [by] us.”

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Grief and doing your own work

Counselors are human, which means that they will experience personal losses throughout their career. Hearing clients talk about the different painful emotions related to the death of a loved one can be triggering for practitioners if they haven’t fully processed their own feelings regarding a loss in their life.

“It’s hard,” acknowledges Karin Murphy, a licensed professional counselor (LPC) with a practice in Doylestown, Pennsylvania. “Counselors have to do their own work [to process loss]. Oftentimes, counselors are not able to talk about it [a client’s grief or loss] because of their own history. It’s an important component of grief counseling: We have to do our own work so we’re able to let that come into the room.”

Ohio LPC Bernadette Joy Graham recently experienced the death of someone close to her, and she stepped away from her counseling practice for a brief time to mourn and process the loss.

“The counselor really has to have themselves rooted with all of their losses,” Graham says. “No matter how well-trained you are as a grief counselor, grief in your own life will be hard.”

As it relates to counselor grief, the 2014 ACA Code of Ethics cautions against practitioner impairment. Professional counselors are called to “monitor themselves for signs of impairment from their own physical, mental, or emotional problems and refrain from offering or providing professional services when impaired.” See more at counseling.org/knowledge-center/ethics, particularly standards C.2.g. and F.5.b.

 

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Action steps for more information

 

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Bethany Bray is a senior writer and social media coordinator for Counseling Today. Contact her at bbray@counseling.org.

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Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

Identifying and addressing competing attachments with couples

By Anabelle Bugatti August 6, 2020

Couples come to counseling for a variety of reasons, and therapists are tasked with understanding the nature of couples’ concerns and offering helpful tools. Sometimes, as therapists, we might hear one partner complain about the things the other partner is doing and, often, these things may seem very trivial. We might also hear clients complain of conflict that centers on a lack of emotional availability on the part of their partner, coupled with their partner escaping or turning elsewhere to de-stress, to get needs met or for emotional sharing.

For example, one person might say, “My partner is always on their phone” or “My husband always takes work calls even during family time” or “My wife shares our fights with her friends” or “My partner would rather play video games than be with me.” Then there are statements that are less trivial, such as, “I think my spouse is having an affair.”

Anything that erodes the security of the bond between partners and creates distress can be seen as a threat to the relationship. The resulting distress must not be viewed as trivial, regardless of how small and harmless the situation may appear on the surface.

A rival to the relationship

A competing attachment is a threat to secure bonding in which one person in a relationship turns away from the relationship and toward someone or something else to get their emotional or attachment needs met. This is often experienced by their partner as a rival to their relationship — someone or something with which they have to compete for their sweetheart’s time
and attention.

Some of these emotional investments or activities on the part of one of the partners may actually be counterfeit attachments. These attachments are an attempt to mimic the fulfillment of comfort, soothing and belonging needs that a secure relationship would typically provide. It is usually the other partner (not the partner engaging in the competing attachment) who initially complains of distress.

The person participating in the competing attachment may or may not be aware that they are turning elsewhere to get their emotional and attachment needs met. This may largely depend on their own attachment style and level of emotional intelligence. Those engaging in the competing attachment are sometimes aware of what they are doing but may try to deny the impact this has on their partner or relationship. 

Depending on the type of competing attachment (what or whom a person turns out to) and the frequency (how often they’re turning out), their partner can be left feeling frustrated, jealous, hurt and disconnected. The more often this occurs, the more distressed the relationship may become. The attachment bond may then start to shift from secure to insecure, or a romantic attachment bond that was already insecure can have that insecurity amplified. Additionally, relationship satisfaction decreases as a relationship becomes distressed by a competing attachment.

Research currently shows a connection between competing attachments and insecure attachment relationships. However, it is unknown whether one causes the other or if an already insecure bond or insecurely attached person might be more vulnerable to developing or experiencing a competing attachment.

While different types of competing attachments tend to pose different levels of threat to a relationship, there is a clear connection between a partner’s concern of competing attachment and their romantic attachment security and relationship satisfaction. In a study conducted for my dissertation research, it was revealed that the more a competing attachment increases, the more the attachment security within the relationship decreases. As attachment security decreases, the more relationship satisfaction also decreases.

Competing attachments constitute a counterfeit attachment in which one partner turns outside of the marriage or relationship and toward something or someone else for escape, soothing, comfort or attention as a substitute for unmet attachment needs. Competing attachments can include addictions, affairs, gaming systems, smart phones, family members or anything else that might lead a spouse or partner to feel it necessary to compete with this “other” for the attachment bond with their partner.

Competing attachments vs. hobbies

It is important to distinguish the difference between a competing attachment and a hobby. Obviously, not everything that someone turns to outside of a relationship will constitute a competing attachment. Clients may have healthy attachments with other people or things that do not violate the boundaries of the romantic attachment relationship between two people and that do not create a feeling of competition for emotional time, attention or affection.

In general, hobbies do not threaten relationships because there are some emotional boundaries involved. Typically, hobbies are engaged in for general enjoyment rather than as an escape or as an alternative to the benefits of their romantic partner. Hobbies do hold the potential of turning into a competing attachment, although this doesn’t usually happen in securely attached people or relationships.

In my clinical practice, I have often heard female partners voice feeling the threat of competing attachment because their partners come home from work most nights and neglect to spend even a little bit of quality time connecting. Instead, they go straight to their gaming systems and play for hours until it’s time to put the children to bed or turn in for the night. Part of what contributes to the sense of a competing attachment is if one partner regularly turns to this “other” before they turn to their own partner or more frequently than they turn to their own partner.

Types of competing attachments

Research has yet to explore every type of competing attachment individually or their respective impact on relationship security and satisfaction, in part because new forms of competing attachment pop up and develop over time. In addition, competing attachments and their impacts can vary culturally. However, a few specific types of competing attachment have been linked to decreases in relationship security and satisfaction.

Addiction

Research on addiction and attachment helps explain how disrupted early life attachment bonds and adaptive mechanisms can, if left untreated, become barriers to emotional flexibility and bonding in adult romantic relationships. When emotional regulation and soothing have not been taught in the context of attachment bonds with a loved one, it can leave the individual more vulnerable to turning to a substance as a means of soothing and escape. On a fundamental level, failed attachment to a primary attachment figure creates alternative attachment to survival mechanisms and defenses. This eventually transitions into attachments to substances or other compulsive behaviors in an attempt to find comfort, soothing, safety, protection and security.

Substances are shown to have analgesic (pain blocking) effects that aid in the numbing out of emotionally painful experiences and situations. Individuals with addiction lack the ability to internally self-regulate their emotions. They frequently turn to substances or compulsions to regulate their feelings of pain or distressing emotional experiences. Nonchemical processes such as pornography and gambling are demonstrated to have similar effects to chemical substances on the brain and can be used by a person to achieve the same effect.

The more frequently someone turns to addictive behaviors to meet their attachment needs, the less often they will seek connection with others. The addiction eventually starts to become a substitute for human connection. Over time, this builds into a false sense of connection, or a counterfeit attachment, because a true and secure attachment bond involves a reciprocal relationship.

In romantic relationships, the consequences for the partner who is not addicted is that they are left emotionally (and, often, physically) alone to deal with emotional distress and the stresses of daily living. Additionally, it is hard to build a secure and satisfying connection with a partner who is not emotionally present, engaged or accessible because of their addiction, especially if the addiction negatively alters the person’s mood. The result is a relationship that is higher in conflict, less emotionally engaged, more unstable or insecure, and less satisfying.

Social media, gaming, smart phones

With the advancement and availability of new technology, the types and frequency of competing attachments have also changed. Internet addiction is a general term used to encompass a wide variety of online behaviors that are problematic for individuals and relationships. For example, addiction to Facebook, Twitter or Instagram has been cited as being intrusive in relationships and is associated with relationship dissatisfaction. Technoference is a term applied to the interference of technology in relationships, including romantic relationships. Another trending term is phubbing, or phone snubbing. This describes when a person turns their attention to a smart phone instead of to their romantic partner or others in a social or personal setting.

As cell phones and gaming systems have morphed from simple electronic devices to devices that encourage participation and interaction online, live human interactions have decreased. Online adult gamers have described sacrificing major aspects of their lives to maintain their online gaming status. Romantic partners report that technologies such as gaming and smart phones frequently interrupt quality time and connection, reduce instances of going to bed together at night, and affect the amount of time spent together on leisure activities. In other words, these partners feel that their relationship has taken a back seat to online gaming activity.

Those who have been phubbed report feeling that their romantic partner favors a virtual world over time and connection with them, thus sending an implicit message about what their partner values most. This has become so problematic in romantic relationships that support groups have been created for “gaming widows” suffering from technoference. Additionally, interviews have revealed that technoference lowers relationship satisfaction and increases conflict between romantic partners.

Pornography

Pornography is unique in that it can encompass two different types of competing attachments: addiction and infidelity (since many romantic partners view pornography as a form of infidelity). Often, the partner who is addicted turns to pornography as a source of stress release or to soothe feelings of shame and disconnection in the romantic relationship.

Research into the experiences of those partners who are not addicted to pornography shows that they often feel in competition with the pornography or the actors in the pornographic material. The turning outside of the relationship to an addiction has also been shown to have a negative effect on the security of the relationship bond and the level of relationship satisfaction.

Affairs and infidelity

Being unfaithful in a romantic relationship (infidelity) is considered one of the most potent threats to romantic attachment security and relationship satisfaction. Infidelity is one of the leading causes of divorce and one of the leading threats of competing attachment.

Unlike other forms of competing attachment, this particular form may need to occur only once for the partner to consider it a competing attachment. What constitutes appropriate or inappropriate behavior with someone outside of the relationship can take on different meanings for different people. For some, a one-time nonsexual encounter in which their partner turns to another may be acceptable, whereas others may find small flirtations that do not result in sexual intercourse unacceptable. For others, finding inappropriate, provocative or sexual pictures or messages exchanged between their partner and someone else may constitute infidelity. The definition of infidelity depends on how the couple delineates the boundaries of their relationship and how they define cheating.

Infidelity, even if only perceived, has the power to undermine the trust, security and satisfaction of the love relationship. Behaviors on social media that violate relational boundaries are also associated with relational insecurity and lower levels of relationship satisfaction.

Factors such as attachment security and satisfaction have been demonstrated to be both consequences and causes of infidelity. Those with secure attachment are less likely to engage in infidelity-related behaviors. There is also a link between attachment avoidance and interest in other partners, as well as strong associations between attachment insecurity and infidelity in relationships. Unmet attachment needs and low levels of relationship satisfaction may contribute to people seeking connection and sex outside of their primary love relationship. 

Rival relationships

Outside or “rival” relationships may not constitute or result in infidelity, but they can still be experienced as competing attachments to the romantic bond. A rival relationship may be any nonromantic relationship that a partner has with another person outside of their love relationship, especially if the outside person is perceived as being attractive. This could be a friend of the opposite sex. Even family members can become competing attachments in some relationships.

In rival relationships, one partner may consistently turn out to a friend or family member to discuss private emotional topics, seek comfort or validation, or share friendly connections that are not shared with their partner or spouse within the love relationship. Another example may be a partner who exchanges text messages, emails or phone calls or engages in private get-togethers with another person outside of the love relationship, particularly if their romantic partner is not invited to take part. The romantic partner may feel like they are being left out of or are on the outside of a friendship or relationship that their partner has.

In therapy, clients might complain about their partner’s closest friend of the opposite gender or an intrusive in-law whom their spouse frequently turns to for advice and emotional support. Rival relationships that involve family members, usually described by clients as “intrusive” family members, are associated with a weaker couple identity and are demonstrated to predict the quality of the couple’s bond.

Interestingly, even in cultures in which men are expected to maintain a strong alliance with their mothers after getting married, wives in these marriages often complain about feeling like they are competing with their mothers-in-law for their place in the family unit. An example might be a husband who frequently puts his mother first by meeting her every need, even after he marries. This type of competing attachment often goes unnoticed. Society tends to dismiss enmeshed mother-son relationships as being potentially problematic, despite the consequences to the son’s marriage or romantic relationship. I am not referring here to a healthy attachment bond between a mother and a son but rather to an unhealthy form of attachment (insecure bonding) that results in the failure of either person to securely and appropriately transition parts of their attachment role when necessary.

Importance to clinical practice

In each of these types of competing attachment, there exists a common link with attachment security (or lack thereof) and relationship satisfaction. As professional therapists, we know that science is clear about the importance of human attachment bonds across the life span. Primary attachment figures were initially considered important for infants and children. However, these roles were later recognized as being important for all humans at all stages, including those with whom we formulate strong romantic attachment relationships as adults.

Each person will have a different attachment style that is classified as either secure or insecure. These attachment strategies are typically stable over time. However, attachment relationship bonds can be defined separately from individuals, also as either secure or insecure. Additionally, there is plasticity in adult attachment relationships. They can shift from secure to insecure and vice versa. In romantic relationships, distress can occur when the security of the attachment relationship is threatened. This is important for therapists to understand as they work with their clients to help them shift from insecure to secure bonding and to build safe and satisfying relationships.

Competing attachments threaten the security and satisfaction of romantic attachment relationships and can become pivotal moments that redefine a couple’s relationship as unsafe. This can additionally create an impasse to relational trust and stability, both of which can negatively affect relational satisfaction. Anything that threatens the stability and satisfaction of an attachment bond is important for clinicians to know about so that they can be prepared to intervene.

Not all things that someone turns to outside of the love relationship qualify as competing attachments. To constitute a competing attachment, it must cross certain boundaries or thresholds that result in distress. If a competing attachment does exist in a relationship and is causing distress, then the relationship satisfaction will start to go down. The less secure the bond becomes between the couple and the less satisfying the relationship is, the more risk exists of the relationship becoming broken. Attachment security is strongly associated with relationship satisfaction. Both attachment security and relationship satisfaction are also important factors in relationship longevity and personal health. Relational satisfaction should remain relatively high and stable over time for most couples in securely attached relationships.

Attachment science offers a guidepost for treatment strategies and interventions for couples who come to therapy reporting the presence of competing attachment.

Treatment recommendations

If a couple comes to your practice complaining of a competing attachment or hinting at the possibility of one, consider asking a few assessment questions. These questions are based off of the Competing Attachment Scale that I created with emotionally focused therapy trainer Rebecca Jorgensen and UCLA professor Rory Reid in 2015 for my dissertation study.

1) Have you experienced in the past or do you currently experience a sense of competition with the activities or relationships in which your partner engages?

2) Do you feel like your partner turns elsewhere outside of the relationship to have their needs met rather than turning to you?

3) Do you feel hurt, bothered or upset by this?

4) Do you feel like this has been a problem in your relationship, created a lot of conflict or affected your ability to get close with or have a healthy bond with your partner?

Also consider the following treatment recommendations for couples reporting distress due to a competing attachment:

  • Clearly identify and understand how the competing attachment is part of a couple’s relational system (their negative interaction pattern or cycle).
  • Identify the competing attachment as an alternative (and ineffective) way of coping with/not dealing with emotional distress or not getting needs met (maladaptive behavior).
  • Help couples turn toward each other as secure bases/safe havens to help co-regulate moments of emotional distress.
  • Help couples find alternative ways of coping with emotional dysregulation that don’t create relational distress or violate relationship boundaries.
  • Help couples identify their emotional/attachment needs and be able to ask for these needs to be met in their relationship.

 

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For more information on adult attachment research, or to find clinical training in your area, visit the websites of the International Center for Excellence in Emotionally Focused Therapy and its founder, Sue Johnson.

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Anabelle Bugatti is a licensed marriage and family therapist with a private practice in Las Vegas. She is a certified emotionally focused supervisor and therapist and is the president of the Southern Nevada Community for Emotionally Focused Therapy. She has a doctorate in marriage and family therapy from Northcentral University. Her new book, Using Relentless Empathy in Therapeutic Relationships: Connecting With Challenging and Resistant Clients, is slated for release at the end of the year. Contact her at anabellebugattimft@gmail.com.

Knowledge Share articles are developed from sessions presented at American Counseling Association conferences.

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Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

The marital paradox

By Guillermo Cancio-Bello and Jim Rudes July 14, 2020

“In relationship with others, people are free to engage in goal-directed activity, or to lose ‘self’ in the intimacy of a close relationship.” — Murray Bowen

There is no shortage of strained marriages. Two people who were once close can grow distant over time and become entrenched in their own positions, which they come to see as being antithetical to those of their spouse. The things they once cherished or found charming have since faded or become an annoyance. Where there was once agreement, now there is discord. Where there was once calm, now the waters are riled. Comfort has turned to uncertainty, and the house once filled with laughter now pulses with quiet (or not so quiet) tensions.

Rarely do couples come in for counseling until the discomfort of that distance, in whatever form it presents, has exceeded their ability to cope with the difficulty and strain it creates. But how does this happen? How can two people who started out so close with each other become so distant?

People are drawn to the comfort, support, intimacy, affection and validation that marriage can offer. That desire for closeness pulls us together. However, when the harmony of that relationship is disrupted, problems begin in the places where each partner has been using the relationship to prop themselves up or ease their personal anxieties in some way. Where one partner suddenly feels invalidated, the other feels wronged by a disagreement. Where one spouse feels anger over the other’s opinion, the other person retreats from their partner’s criticism. The forms these disruptions can take are endless.

What happened?

In the beginning of a relationship, most of us are more flexible and adaptable in the presence of the other than we otherwise might be. We put on a layer of maturity that doesn’t necessary reflect our true level of functioning. We are able to do this because the nature of the relationship early on has less tension. We listen to the other, we share our opinions openly, we ask questions and engage in conversation, we are curious about our partner and their views, and we are warm, kind and affectionate. Our immaturities somehow become minimized. And thank goodness that is the case, or else we might never get together.

However, that layer of maturity we put on is temporary. It is a reaction to the pull of closeness and harmony with the other. We are not implying that this action is all pretend or fake but rather that part of it does not reflect the reality of our functioning. It is a mechanism that fosters the closeness both individuals desire.

When that maturity slips off, and when our immaturities rear their heads, each individual in the relationship can begin to wonder what happened to the other. Each person begins to assume that the other has changed, and each assumes that the other is the one inhibiting the restoration of intimacy and harmony. This is the distance that pushes apart people who were once so close. Both become entrenched in their position that the other is the problem, and the relationship patterns that maintain the distance become fixed.

This is when people tend to seek counseling. So, what can we do as professional counselors? Working from the framework of Murray Bowen’s family systems theory has helped us acquire and maintain perspective about the relationship between two people. Its systemic underpinnings allow us to conceptualize the relationship without placing blame or seeing fault in one partner or the other. The theory focuses on the processes between people rather than the content of the arguments, which can create a din of noise in which both counselor and clients can easily become entangled and lost.

Focusing on the  ‘other’ as the problem

All marriages have tensions and difficulties because any two-person relationship has instabilities built into it. People want to be together with others, but they also want to maintain their autonomy. When things are working well in a relationship, people feel connected but also free to be themselves. When people feel too close or too distant, it causes a disruption in the individual and, ultimately, in the relationship.

We want attention from our partners, but we can become allergic to too much of it, pushing the other away or distancing ourselves emotionally from them. And when we get the space we think we want, we can feel unappreciated and look for affection and validation to make us feel connected and secure. In this emotional seesaw, each person becomes sensitive to the other and what they do or say and can begin to focus on them as the problem: If only my partner would give me more attention. If only my partner would step up and do their part. If only they would listen to me. If only, if only, if only …

The reality is that both parties contribute to any relationship difficulty. That is the nature of reciprocity, but it is a fact that we all have trouble seeing when we are in the midst of relationship tensions and the emotions and anxiety they produce.

The more that tension and anxiety build, the more reactive people get, and the more they unwittingly contribute to the reciprocity, or mutually influenced pattern, that maintains the “problem.” When people get anxious and reactive, they tend to focus on what is wrong in or with the other rather than looking at what they are doing, how they are contributing to the maintenance of the “problem,” and what their options for changing their own thinking and behavior might be.

Especially in intimate relationships, people can get bogged down in the tensions of feeling misunderstood, neglected or mistreated in one way or another. It can be difficult for individuals in a relationship to see beyond the dust cloud of an argument, a history of small misunderstandings, the minute experiences of neglect that one feels toward the other but has never vocalized, and so on. These histories build because people want stability and harmony in the moment and are willing to sacrifice some autonomy for that without realizing they are contributing to a process that will later result in an eruption.

In our experience, many initial sessions with couples begin with an attempt by both parties to pull the counselor into a he said, she said tug of war. Both want the comfort of togetherness with their counselor, albeit at the expense of their relationship with each other. We believe it is the counselor’s responsibility to stay out of it. The minute that clinicians start seeing one partner or the other as an angel or demon, they have lost their objective footing.

The two overarching and interlocking steps counselors can take to guide people through the process of working on themselves in their relationships are:

1) Help each person increase their perspective of how they relate to their partner.

2) Help each person work on themselves in the present.

As with any idea, the simpler it seems, the more difficult it is.

Increasing perspective: Seeing the reciprocity

Helping people increase perspective begins with the counselor’s ability to maintain a larger perspective. Rather than seeing sides of the relationship, the goal is to focus on the processes and patterns to which both parties contribute, much like a coach looking over the field from above and watching what each player does. If the counselor is able to keep perspective, they can be useful to their clients by helping them gain a larger view of what is going on in their relationship.

Step 1: Decrease anxiety. Nothing can happen until the anxiety in each individual comes down to a level at which they can both work on their part. Often, just talking can help bring down the anxiety. Setting up your expectations (as the counselor) for the session can also help limit the escalation of tensions. One of the biggest factors in decreasing the anxiety when a couple is in the room is the counselor’s ability to remain objective and neutral.

Step 2: Take a step back. Have the couple take a step back from the intensity of the moment by widening the lens they are using to view the problem. Often, each person is hyper-focused on the other, so taking a step back means having each person shift their focus off the other and onto their own functioning. When one person begins talking about what the other is doing, you can help them shift the focus by asking questions about their thinking on their own behavior and thoughts.

For example, if one person begins telling you how the other never says anything, never has an opinion, and is just so limp and passive, you might respond with questions about what they do and think when their partner does those things or what they are doing and thinking before the other partner reacts passively. Conversely, when one partner tells you that the other partner is angry all the time, comes at them with high intensity and is critical, you might question what they do when that happens or how often they anticipate their partner’s intense reactions.

Step 3: Highlight the reciprocity. Continually point out the reciprocity in the “problem” — the fact that each person is contributing in some way to the maintenance of what is going on. Highlighting the reciprocity helps each person begin to recognize that they are an equal participant in what is going on in the relationship, and it furthers the process of each individual shifting their view of the other as the problem to focusing on their own functioning. Using the example above, you might point out to the couple how interesting it is that each time one partner gets intense, the other becomes passive, and how when one becomes more passive, the other gets more intense.

The beauty of this perspective is that it is never up to one person to change the other. There is always something for each person to work on individually, and in doing so, each person is also working on the relationship. There is always a way to move because the processes between two people are constant and ever flowing, even if the participants are locked into automatic and reactive behaviors. A change in one person sets off a change in the process between the two. It is nonsensical for one person to blame the other because they are each contributing, and have contributed, to what is going on between them in the present.

This shift in focus — from off of the other and onto the self — is necessary for each person to move forward effectively. If this shift isn’t made, people tend to either get stuck in conflict or give up more and more of the self to keep the relationship stable. A little conflict is better than a false stability.

Working on self in the present: Working on the reciprocity

Taking a step back and gaining perspective allows people to reenter the tensions of the present moment with more clarity because the focus has shifted from off of the other and onto the self. Once that shift in focus has been made, people can work on managing their emotions and anxieties in the here and now. But these two steps are inextricable because the knowledge gained by looking at and understanding one’s part in relationship patterns is the catalyst for better managing self in the present.

Step 1: Watch the reciprocity. Once each person has begun to see the reciprocity and recognize that they are an equal contributor to the relationship tensions, then they can begin to work on their part. The first step is helping each person become an expert on how they contribute to the reciprocity. What you are doing as a counselor is moving the clients’ thinking from a cause-and-effect framework to a systemic framework in which the rule is reciprocity.

After seeing it, people can begin to be aware of the reciprocity in the present. That awareness might show up in session as one person reflecting on how when their partner got angry, they “retreated again.” In response, their partner increased their intensity, and this person reacted to that increase by shutting down. The client’s focus is now on the process and their part in it.

Step 2: Work on the reciprocity. As each person becomes an expert on their part in the process between the two, they simultaneously begin to work on themselves in the present moment and in the reciprocity that is always ongoing. As the partner from the example above begins to see that their “retreating” and “shutting down” contribute to the other partner’s increasing intensity, they can begin to work on staying engaged in the relationship under pressure. This might begin with noticing their impulse to retreat and staying in the conversation a bit longer than they normally would despite the “feeling.”

In other words, they are tolerating the discomfort of the feeling, but that tolerance is driven by a thoughtful framework regarding the nature of reciprocity and their part in that process. It might mean recognizing that the partner’s intensity is not a critique on them but is rather about their partner’s own functioning. Thus, the first partner may begin to take things less personally. We could go on and on here, but the point is that this person begins to be less caught up in the emotional intensity of the moment. In doing so, the person is able to be less reactive and more thoughtful in what they do and how they do it. The more they work on themselves in the reciprocity, the more options they have in how they function, and the greater the chance for the relationship to improve.

We focused on one partner above, but we could do the same exercise with the other partner. That person would begin by seeing the reciprocity of increased intensity by them and withdrawal by the other partner. They might begin to watch their own functioning, recognizing that the more intense they get, the more their partner retreats. They might notice that when the other retreats, their own intensity automatically increases. They might begin to work on managing that impulse and their facial expressions, tone of voice and so on in the presence of the other. And in working on themselves, they might begin to see that they are working on the relationship.

The challenge as the counselor is to continually bring the focus of the session back to the process of what is going on, or has gone on, and to stay out of the content. Any couple will tend to slide back into content — who said or did what to whom — when tensions and anxieties rise. It is the counselor’s work to stay neutral and objective and to point back to the process of what is going on.

Just as the paradox of marriage is for each individual to manage the self, the paradox of counseling is that the counselor must manage the self rather than try to change whomever is sitting before them. We see the work of the counselor as being no different than the work we perceive as useful to clients. In other words, if the counselor is getting lost in the content of a couple’s argument, then the counselor is not managing their own self, and their anxieties have taken over. But if the counselor can stay focused on the process of how the couple argue, how this contributes to the larger patterns of their relationship, and how that is tied to a history of behavior of which they both are a part, then the counselor is being useful in some way and is managing the self, at least a little bit.

 

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Guillermo Cancio-Bello is director of the November Institute, where he works to bring natural family systems thinking to the lives of individuals, families and organizations in the pursuit of growth through a deeper understanding of human relationships. He is currently undertaking a Ph.D. in counseling at Barry University and lives in Miami with his wife and two dogs. Contact him at thenovemberinstitute@gmail.com or visit thenovemberinstitute.com.

Jim Rudes is an associate professor of counseling in the Adrian Dominican School of Education at Barry University. He has more than 20 years of clinical experience, and for the last several years has devoted most of his professional energy to the study of family systems through the lens of natural family systems theory. His current research interests are concerned with emotional process versus content, and the light at the end of the tunnel. Contact him at jrudes@barry.edu.

 

Counseling Today reviews unsolicited articles written by American Counseling Association members. To access writing guidelines and tips for having an article accepted for publication, go to ct.counseling.org/feedback.

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Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.